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10.0 - 15.0 years
15 - 20 Lacs
Mumbai, Mumbai Suburban, Mumbai (All Areas)
Work from Office
Role Overview: We are seeking a dynamic and experienced professional to lead our Employee Benefits Client Servicing team. This individual will be responsible for driving service excellence, managing high-value corporate relationships, and overseeing a team of servicing professionals to ensure timely and quality delivery of EB solutions. The ideal candidate will possess deep technical knowledge of EB products and strong experience in managing group health and life claims, client relationships, and internal cross-functional coordination. Key Responsibilities: Client Leadership & Relationship Management Act as the senior point of contact for key EB clients. Build and maintain strong C-level client relationships, understanding their evolving needs. Lead client governance meetings, renewal discussions, and strategic reviews. Team Management Lead, mentor, and manage the EB Client Servicing team across locations. Define KPIs, ensure adherence to SLAs, and continuously improve team performance. Develop team capability through training, coaching, and performance management. Policy Administration & Endorsements Oversee and ensure timely processing of endorsements including addition and deletion of employees and dependents in line with client requirements and insurer guidelines. Ensure accuracy and completeness in data sharing with insurers/TPAs for seamless endorsements. Implement standard operating procedures to track and audit endorsement workflows. Claims Management Oversee end-to-end claims handling processes for group health, life, and other benefits. Liaise with insurers and TPAs to ensure timely and accurate claim settlements. Resolve escalated claim issues, ensuring high client satisfaction and minimal friction. Organizing Wellness activities for the clients. Process Improvement & Delivery Excellence Streamline service workflows for efficiency and scalability. Standardize client onboarding, MIS/reporting, policy documentation, and service charters. Drive implementation of digital servicing tools or platforms for enhanced client experience. Internal Collaboration Work closely with Placement, Sales, Underwriting, and Product teams to ensure coordinated service delivery. Lead internal service review meetings and present account-level insights to management. Wellness Program Management Conceptualize, organize, and implement employee wellness programs for corporate clients, including health camps, awareness sessions, webinars, and engagement initiatives. Coordinate with wellness vendors, medical partners, and clients for seamless execution. Track participation metrics and client feedback to enhance future wellness offerings. Technical & Professional Skills: Deep domain expertise in Employee Benefits, especially Group Health, Group Life, and Wellness offerings. Strong knowledge of insurance regulations, IRDAI guidelines, and TPA processes. Proven experience in managing large-scale employee benefit programs and high-volume claims. Excellent communication, stakeholder management, and conflict resolution skills. Advanced proficiency in Excel, PowerPoint, and client-facing reporting tools. Strategic mindset with strong execution capability.
Posted 6 days ago
5.0 - 8.0 years
10 - 14 Lacs
Hyderabad
Work from Office
Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Business Requirements Analysis Good to have skills : Insurance Claims, Guidewire BillingCenter BAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. Your typical day will involve collaborating with various stakeholders to gather requirements, ensuring that the applications meet business needs, and overseeing the development process to deliver high-quality solutions. You will also engage in problem-solving and decision-making to guide your team effectively, fostering an environment of collaboration and innovation. Roles & Responsibilities:- Expected to be an SME.- Collaborate and manage the team to perform.- Responsible for team decisions.- Engage with multiple teams and contribute on key decisions.- Provide solutions to problems for their immediate team and across multiple teams.- Facilitate knowledge sharing and mentoring within the team to enhance overall performance.- Monitor project progress and ensure alignment with business objectives. Professional & Technical Skills: - Must To Have Skills: Proficiency in Business Requirements Analysis.- Good To Have Skills: Experience with Guidewire BillingCenter BA, Insurance Claims.- Strong analytical skills to assess business needs and translate them into technical requirements.- Ability to communicate effectively with both technical and non-technical stakeholders.- Experience in project management methodologies to ensure timely delivery of projects. Additional Information:- The candidate should have minimum 5 years of experience in Business Requirements Analysis.- This position is based at our Hyderabad office.- A 15 years full time education is required.- Resource need to work in Shift B(12:30pm till 10:00pm) Qualification 15 years full time education
Posted 6 days ago
1.0 - 2.0 years
1 - 3 Lacs
Raipur
Work from Office
Review and interpret diagnostic and clinical reports Summarize patient findings in a standard reporting format for clients/insurance partners. Ensure accuracy and consistency in medical terminology and conclusions.
Posted 6 days ago
0.0 - 1.0 years
0 - 1 Lacs
Hyderabad
Work from Office
Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Client Servicing Responsible for developing the corporate customer base for MDIndia Health Insurance Services. Map the territory and maintain a strong pipeline of potential customers. Establish Contacts with key persons at the corporate and understand the current levels of Health Insurance services and needs. Develop strong relationship with Insurance Companies/Brokers. Promptly attending Emails, Phone calls, Whats App messages of Clients. Maintain proper MIS & Internal reports and present it to the management. Ability to work independently, achieve targets and be absolutely result oriented Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive Two wheeler is Mandatory If interested kindly share your resume to ta4@mdindia.com
Posted 6 days ago
3.0 - 6.0 years
5 - 6 Lacs
Noida
Work from Office
Job title :- AM - IPD Billing & TPA (Deduction Recovery) To Manage the TPA/Insurance Agreement and tariff updation and coordinate with TPA Insurance for payment follow up along with max internal team as well for day-to-day work. Role & responsibilities To ensure customers TPA outstanding recovery within defined timelines. Achievement of assigned collection Targets. To maintain Insurance Tracker and updating of case status in E Prapti on weekly basis. Recovery of Top up deduction cases. TPA status of Outstanding cases prior to 30 days (Inclusive of Less than Rs. 10000). Bill docket receiving status prior to 30 days (Real time status basis on TPA records). Outstanding details to be shared with TPAs by 7th of every month. Relationship building with TPA key persons and arranging value added services across Pan max units. Working with TPAs networking/ Operation Managers to identify payout delay reasons and mitigate any issues being seen at TPA/MHC end. To provide NEFT dump to On Account team on fortnight/ Monthly basis. Resolution of On Account Team concerns/ requirements with in TAT of 72 hours. To capture correct status, TIN/CIN, Insurance Company name in Insurance Tracker. Post discharge Query resolution and updating in E Prapti. To identify reasons of wrong settlement cases and correction to be done with help of On-Account & Finance Team. Weekly report on action done against cheque Re Issue/paid by TPA but payout not received cases. Weekly TPA Visit Call Report. (Format already shared). On Account Settlement Prior to 90 days. Cashless Troubleshooting Assisting unit Front office/ Billing teams on day-to-day issues faced during hospitalization of patient. Data/ records maintaining of support extending to unit TPA teams for cashless troubleshooting cases. Maintaining relationship & regular visits to Pan Max units. Preferred candidate profile Qualifications - Graduate Experience - 3 to 5 years; Preferably with 2 years of healthcare experience Please share your CV deen.dayal@maxhealthcare.com
Posted 6 days ago
0.0 - 5.0 years
2 - 4 Lacs
Ahmedabad
Work from Office
Shift: Night | Mon–Fri Work Mode: On-site (Office-based) Salary Structure: Freshers: 23,000 CTC/month Experienced: 28,000 – 35,000 CTC/month Incentives: Increment after 3 months based on performance
Posted 1 week ago
2.0 - 7.0 years
7 - 8 Lacs
Noida
Work from Office
Call us - 8271273330 Experiences preferred- Property and Casualty Insurance Claims Mortgage Underwriting Denial Management Location- Noida Salary - 25-30% hike on last drawn.
Posted 1 week ago
5.0 - 10.0 years
4 - 8 Lacs
Chennai
Work from Office
"Positions General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job Be a team player and work seamlessly with other team members on meeting customer goals Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function Handle reporting duties as identified by the team manager Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. To be in a position to handle training for new hires Work together with the team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case of any defaulters. Encourage the team to exceed their assigned targets. Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 5+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts. ***Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend s basis business requirement."
Posted 1 week ago
1.0 - 5.0 years
1 - 3 Lacs
Bengaluru
Work from Office
Role & responsibilities An IP Billing professional, whether an executive or staff member, is primarily responsible for managing and processing billing activities related to intellectual property (IP) or inpatient (IP) services . This involves maintaining accurate records, generating invoices, ensuring timely payments, and handling billing inquiries. They also play a crucial role in ensuring compliance with relevant regulations and collaborating with other teams, such as finance and legal, to streamline processes. Preferred candidate profile A strong candidate for an IP billing role, particularly within a hospital setting, should possess a blend of financial and administrative skills, along with a solid understanding of healthcare billing processes . Key requirements include a degree in finance, accounting, or a related field, experience in billing or insurance verification, and strong numerical and analytical abilities. Familiarity with billing software, hospital information systems, and relevant regulations (like HIPAA) is also essential.
Posted 1 week ago
3.0 - 8.0 years
4 - 8 Lacs
Bengaluru
Hybrid
About Client Hiring for One of the Most Prestigious Multinational Corporations!! Job Title: Property and Casualty insurance Qualification: Any Graduate and Above Relevant Experience: 4 to 8 years Must Have Skills : 1.Problem solving skills: Investigative, analytical, detail-oriented nature. 2.Organizational skills: Able to multi-task, establish priorities, complete tasks/assignment in a timely manner and comply with process requirements 3.Exceptional commitment to customer service. 4.Interpersonal Skills: Demonstrates solid relationship building skills by being approachable, responsive and proactive 5.Should demonstrate collaborative working 6.Communication: Communicates orally and in writing clearly, concisely and professionally. No MTI, able to articulate while on call. 7.Attitude: Positive Mindset, maturity and friendly behavior. 8.Flexibility: Should be flexible with shifts. Good Have Skills : Experience into International commercial insurance for Property and Casualty claims/ insurance. Roles and Responsibilities : 1.Operates a variety of client systems and performs complex tasks and activities without supervision following information security policies, procedures and guidelines. 2.Meets and exceeds client performance standards. 3.Interacts with co-workers and supervisors to audit and troubleshoot to meet client needs in a timely manner 4.Takes initiative to find solutions and works effectively as a member of the team 5.Develops and implements procedures to meet quality, quantity, and timeliness standards. 6.Composes clear, polite, and well-organized emails to communicate with clients. Anticipates client needs proactively and takes initiative. 7.Coaches less-experienced staff in learning procedures and insurance knowledge. 8.Analyzes the root cause of processing problems and keeps team and supervisor, and client informed of issues and solutions. Location : Bangalore CTC Range : 4LPA -8 LPA (Lakhs Per Annum) Notice Period : Immediate - 30 Days Mode of Interview : Virtual Shift Timing : US shift Mode of Work : Hybrid -- Thanks & Regards, Lakshmi PS HR Analyst Black and White Business Solutions Pvt Ltd Bangalore, Karnataka, INDIA. Direct Number: 080-67432489/WhatsApp @ 7892150019 lakshmi.p@blackwhite.in | www.blackwhite.in ************************ Refer your Friends and Family ********************************
Posted 1 week ago
6.0 - 11.0 years
0 - 0 Lacs
bangalore
On-site
Were Hiring Team Lead / SME (International Voice Process) Location: Bangalore Experience: 610 Years Notice Period: Immediate to 30 Days Join a top MNC and lead high-performing teams in an international voice support environment. Looking for strong people managers with excellent communication and escalation handling skills. To apply, send your CV to: afreen@liveconnections.in Or WhatsApp: 8297161110
Posted 1 week ago
5.0 - 10.0 years
10 - 15 Lacs
Thane, Mumbai (All Areas)
Work from Office
Underwriting of Retail Health, Personal Accident & Travel proposals Team Management IRDAI related UW activities Processing of Non Disclosures/Frauds /Audit /ISO/IRDA data Crucial MIS & analysis for Garo data Back up for handling pre-policy activities Required Candidate profile BAMS, BHMS, BDS or Similar 5+ years of experience in Health Insurance & Underwriting Good knowledge of Risks, Processes & Data Collection & Analysis Must know IRDAI related process Good communication Perks and benefits Good Opportunity
Posted 1 week ago
1.0 - 3.0 years
2 - 3 Lacs
Guwahati
Work from Office
Responsibilities: Process insurance claims efficiently Manage motor insurance policies accurately Collaborate with clients on policy management strategies Ensure compliance with regulatory requirements Visit Insurance offices and agents to tieup with them Office cab/shuttle Food allowance Annual bonus
Posted 1 week ago
1.0 - 3.0 years
2 - 3 Lacs
Chennai
Work from Office
Job Details: Job Process/Role: Claims Adjudication (US Healthcare) Experience: 1 - 3 Years of Relevant experience in Claims adjudication Skillset: CPT Codes, HIPAA, Co-pay and Co-insurance, Medicaid and Medicare, Denial claims, UB and CMS forms. Shift: Night shift Location: Chennai Mode of Work: Work from the office Notice Period Eligible: Immediate to 30 Days of Notice period is acceptable. Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials. Knowledge in handling authorization, COB, duplicate, pricing, and the corrected claims process. Knowledge of healthcare insurance policy concepts, including in-network, out-of-network providers, deductible, coinsurance, co-pay, out-of-pocket, maximum inside limits, and exclusions, state variations. Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services, and processes performed by the team. Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication, and the adjustment process. Experience in professional (HCFA), institutional (UB) claims (optional). Both undergraduates and postgraduates can apply. Good communication (Demonstrate strong reading comprehension and writing skills). Able to work independently, with strong analytical skills. 1. Required schedule availability for this position is Monday-Friday, 5.30 PM/3.30 AM IST (AR SHIFT). The shift timings can be adjusted according to client requirements. 2. Additionally, resources may have to work overtime and on a weekend basis to meet business requirements.
Posted 1 week ago
5.0 - 7.0 years
4 - 6 Lacs
Bengaluru
Work from Office
Job Description: Job Title : Senior Medical Officer Investigation Team Department : Investigation Location : [Insert Office Location] Reports To : Head Claims Investigation Employment Type : Full-time Job Purpose: The Senior Medical Officer will lead and support the investigation team by reviewing, evaluating, and investigating health insurance claims to ensure medical appropriateness and detect fraud, waste, or abuse. The Senior Medical Officer will act as a bridge between medical knowledge and investigator, playing a key role in ensuring fair and accurate claim settlements. Key Responsibilities: Evaluate high-value and suspicious claims by reviewing medical documents, patient history, and treatment records. Verify and scrutiny the claim documents. Guide and supervise field medical officers and investigators in collecting and interpreting clinical information. Identify inconsistencies, over-utilization, or fraudulent patterns in medical claims. Handle escalations and responding to mails accordingly. Support legal or compliance teams in preparing medical reports or expert testimony in fraud cases. Assist in preparing MIS reports, audits, and documentation related to claim investigation outcomes. Ensure adherence to IRDAI guidelines and internal medical policy frameworks. Train and mentor junior medical officers and non-medical investigators on claim evaluation practices. Productivity ( Achieve the daily targets ) Maintaining TAT Required Qualifications & Skills: Experience: Minimum 57 years ( in clinical practice and/or health insurance, with at least 2 years in claim Auditing) Strong knowledge of medical procedures, diagnostics, hospital protocols, and insurance norms Excellent analytical and documentation skills Good communication and interpersonal skills to coordinate with medical and non-medical stakeholders Decision Making Analytical Skills Familiarity with health insurance fraud indicators and regulatory compliance Proficiency in using medical claim systems and MS Office tools Industry Type : Insurance Department: Health care & Life Science Education: Preferred Attributes: Prior experience in a health insurance company, TPA, or investigation agency
Posted 1 week ago
0.0 - 3.0 years
1 - 2 Lacs
Bengaluru
Work from Office
Job Title: Insurance Desk Executive TPA Coordination / Claims Specialist Location Options: Cloudnine hospital Sarjapura branch (BLR) BBMP Khata No: 1907/Sy No: 26/1, 26, 2nd Main Rd, Kaikondrahalli, Haralur, Bengaluru, Karnataka 560035 - Sarjapur Cloudnine hospital Thanisandra branch (BLR) Address: Sy No: 86/2 and 86/3, Thanisandra Village, Thanisandra Main Rd, RK Hegde Nagar, Bengaluru, Karnataka 560077 Organization: Ayu Health Hospitals Experience Required: 02 years (Freshers are welcome to apply) Preferred Gender: Male Candidates Preferred Location: Candidates residing near hospital locations will be given preference About Ayu Health: Ayu Health is one of Indias fastest-growing healthcare networks, dedicated to making high-quality healthcare accessible and affordable for all. With a focus on technology-driven solutions, Ayu Health partners with reputed hospitals and clinics across the country to deliver standardized care, transparent pricing, and a seamless patient experience. We are on a mission to build Indias most trusted healthcare brand. Key Responsibilities: Handle insurance/TPA desk operations at the hospital premises Coordinate with TPA and insurance representatives for claim submission and follow-up Manage and organize patient insurance documentation accurately Track approvals, follow up on pending claims, and address rejections effectively Communicate professionally with patients, hospital staff, and insurance partners Support hospital administrative needs and maintain documentation records Multi-task and work collaboratively within the hospital environment Candidate Requirements: 02 years of experience in TPA coordination, insurance desk, or claims processing in hospitals (Freshers with good communication skills can apply) Strong interpersonal and communication skills Basic understanding of hospital processes is a plus Ability to manage documents and work efficiently under pressure Must be reliable, punctual, and a team player Preference will be given to candidates living nearby the hospital location Male Candidates only Immediate Joiners will be preferred
Posted 1 week ago
2.0 - 3.0 years
1 - 4 Lacs
Surat
Work from Office
You would be responsible for managing the end-to-end claims process for clients, ensuring seamless handling from claim intimation to settlement follow-ups. You will be the key point of contact for clients and AMCs regarding claim processes. You should be strategic and detail-oriented, ensuring timely documentation, filing, and resolution of claims while also contributing to business growth through lead generation and upselling. Requirements You have a bachelors degree in administration, commerce, or a related field. 2-3 years of hands-on experience in insurance claims processing. Ability to communicate correctly and clearly with all customers. Maintain a positive attitude with a focus on customer satisfaction. Documentation and organizational skills.
Posted 1 week ago
1.0 - 6.0 years
1 - 6 Lacs
Bengaluru
Work from Office
HIRING For Motor Claims & Body Injury Claims Location - Whitefiled 5 days working & Sat sun fixed off Graduates salary - 6.5LPA CONTACT Gopika - 7411782490
Posted 1 week ago
2.0 - 4.0 years
4 - 6 Lacs
Bengaluru
Work from Office
Salary goes up to4LPA -6LPA Graduates with minimum 1.5 years into the specified domain, 5days working sat and sun off 2 way cab Fixed uk shift
Posted 1 week ago
1.0 - 3.0 years
4 - 6 Lacs
Bengaluru
Work from Office
Immediate joiners or with in 15 days Salary goes up to 6LPA-6.5LPA Graduates with minimum 1.5 years into the specified domain, Sat, Sun fixed off ,2 way cab Fixed uk shift White field location Note : Experience candidates only - on same domain
Posted 1 week ago
3.0 - 8.0 years
3 - 8 Lacs
Pune
Hybrid
Role & responsibilities Strong understanding of Banking and services. Incorporates product knowledge into internal and external customer communications Demonstrates knowledge of insurance and claims industry Understands who to go to for additional information Communicates in a timely and effective manner (verbally and written) Understands priorities and objectives to ensure all deadlines are met Claims Management Risk Management Insurance Programs Reconciliation Preferred candidate profile Graduated from finance background
Posted 1 week ago
0.0 - 4.0 years
1 - 3 Lacs
Thane, Navi Mumbai, Mumbai (All Areas)
Work from Office
Renewal process life insurance Good communication. Salary upto 24k ctc Day Shift Rotational week off Need Linguistic candidates Gujrati, Malyalam, Punjabi Required Candidate profile HSC is mandate How To Apply..? To schedule your interview Call or send your CV through WhatsApp number mentioned below HR Priyanka:- 7875990932
Posted 1 week ago
1.0 - 3.0 years
2 - 2 Lacs
Chennai
Work from Office
Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.
Posted 1 week ago
1.0 - 5.0 years
0 - 2 Lacs
Chennai
Work from Office
Greetings from NTT DATA, Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.
Posted 1 week ago
1.0 - 5.0 years
2 - 4 Lacs
Kolkata
Work from Office
Job Responsibilities: ***ONLY BHMS GRADUATES CAN APPLY.*** Having experience (at least 5 yrs) in TPA claim processing. Having a Good relationship with Hospitals under the East Zone. Financial Contribute to renewal portfolio expansion through relationship building with the insurance companies and surveyors to ensure optimum claim settlement in minimum time During processing of claim analyse the following and communicate to underwriters: adequacy of sum insured anomalies in the policy scope of additional policies other related information Control expenses Business Process Facilitate proper settlement of the claim in the shortest possible time to the satisfaction of the client by ensuring the following: Obtain complete information on the loss from the client after initial intimation Submit intimation to the insurance company for Registration of claim Allocation of a surveyor Obtain LOR (List of Requirements) from the Surveyor Match LOR with the Salasar requirement already taken from the client and take rest of the documents Once documents are received, check exclusions in fine print and prepare the draft reply from client submitted to insurance company Follow up with client for repair and reinstatement for early completion and help in documentation of estimate, contractor details, expenses etc. so that surveyor gets structured inputs for preparation of the survey report Follow up with surveyor for completion of assessment Communicate surveyors comments to client in terms of estimate and exclusion and arrange meeting between surveyor and client to resolve differences to obtain client assessment Ensure surveyors report is submitted at the earliest Follow up with insurance company for early settlement of claim Obtain settlement voucher from insurance company and forward to client Get discharge of client (signoff) and submit to insurance company for disbursement Update each step in SAIBA on real time basis and ensure due IRDA compliance Ensure resolution of all complex technical issues in claims and timely escalation of the same for quick disposal of the claim Customer Support the marketing department in obtaining new business and ensuring best possible coverage for client, talk to technical dept of client to understand which risks need to be covered, type of production (continuous/ batch) Reopen claims in case of new businesses and follow up to obtain claims after reopening of file by insurance company if repudiation is not time-barred Participate in fortnightly meetings to give updates to the business development and client servicing teams on the status of claims in order that they are updated about the same before meeting client for renewals Interface with clients to reinforce relationship with existing clients Prepare and submit daily / monthly reports on status of claims People Growth Acquire product knowledge and always keep self updated with latest variations in product offerings Attend training sessions (external/ internal) and working on on-job assignments to implement new learning Conduct training sessions for marketing team as well underwriting and claims teams to build product knowledge across functions Set objectives, review and evaluate performance periodically and give feedback Review pending work and initiate action Perform all such duties which are required to be performed by this position in an insurance broking house in general course and to perform all such duties and carry out all such responsibilities so delegated or asked to be performed by the Designated Authority from time to time External Interface: Internal interface: Existing clients Prospective clients Insurance companies Employees Preferred Competencies of Incumbent a) Functional Competencies Demonstrates domain knowledge in own area of operation Understands product offerings Understands service standards as per the Organization's ethos Learns continuously and keeps self-updated b ) Leadership Competencies : Relationship Building Networks effectively with both external and internal customers Focuses on building long-term, sustainable relationships Delivers on commitment every time Creative & Analytical Problem Solving Understands the strategic objectives of the Organization, unit, and function Collates data and analyses them objectively Takes objective decisions based on data to achieve the strategic objective of the Organization Goes the extra mile to achieve creative solutions Customer Focus Designs solutions that meet the requirements of the customer (external/ internal) Demonstrates a sense of urgency to resolve all external and internal customer concerns and responds to queries and requests within defined timelines and processes Educates customers (external/ internal) about changes in processes, policies and offerings Creates long term relationships with customers (external/ internal) through continuous interface Obtains customer (external/ internal) feedback to improve processes Promotes loyalty and converts customers to brand ambassadors Achieves customer delight concerning both internal and external customers Is sensitive to the code of conduct in the office and customer establishments Perseverance Makes every possible effort to understand the viewpoints of external and internal customers Takes all possible steps to resolve issues Understands the importance of deadlines, proactively removes roadblocks, and delivers as per requirement Tries alternatives to achieve the target Does not give up in the face of adversity Explains own point of view assertively to get necessary support and approval Is patient and persistent towards follow-up on all leads and prospects generated during the past, towards new client acquisition Achievement Orientation Understands the strategic objectives of the Organisation, unit, and function Aligns individual and team targets with strategic goals Plan and deploy appropriate resources to meet targets in the short and long term Goes the extra mile to achieve targets as per committed timelines and enables the team to do so Achieves and motivates excellence irrespective of circumstances Shares best practices across businesses Benchmarks with the best and continuously raise the bar Upgrades competencies of self and team to achieve excellence Interested candidate can share their CVs at susweta@salasarserviecs.com
Posted 1 week ago
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